ART Monitoring, ADR & Substitution Guide Adverse Drug Reaction Management & Single-Drug Switch Pathway · v1.0
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⚙ Principle: Substitute the single offending drug. Do NOT switch the entire regimen for a single-drug ADR. A full regimen switch is only for virological failure.
1. Current Regimen
2. Identified Adverse Drug Reaction
3. Relevant Parameters
⚙ NACO Monitoring Schedule by Regimen
Investigation TDF-based AZT-based All Regimens
Serum Creatinine / CrCl Baseline, 3 months, then 6-monthly Baseline As indicated
CBC with Differential Baseline Baseline, 4 weeks, 3 months, then 6-monthly As indicated
HIV Viral Load 6 months, then annually 6 months, then annually Primary measure of treatment success
CD4 Count Baseline, 6 months Baseline, 6 months Discontinue once stable > 200 on suppressive ART
ALT / AST Baseline, as indicated Baseline, as indicated More frequent if NVP-based or HBV coinfection
Fasting Glucose / Lipids Baseline, annually Baseline, annually DTG: monitor for metabolic syndrome
Urine Dipstick Baseline, 6-monthly (glycosuria, proteinuria) Baseline Screen for TDF tubular toxicity
Pregnancy Test As indicated As indicated All women of childbearing age at each visit
ADR Recognition Quick Reference
DrugKey ADRTime to OnsetAction
TDFNephrotoxicity, Fanconi syndrome3 to 12 monthsSwitch TDF to AZT or ABC
AZTAnaemia, neutropenia4 to 12 weeksSwitch AZT to TDF or ABC
AZTMyopathy, lipoatrophy6 to 18 monthsSwitch AZT to TDF
ABCHypersensitivity ReactionFirst 6 weeksStop immediately. NEVER rechallenge.
DTGNeuropsychiatric, weight gainWeeks to monthsSwitch to EFV (if tolerated) or ATV/r
EFVCNS toxicity, gynaecomastiaFirst 2 to 4 weeksSwitch EFV to DTG
NVPHepatotoxicity, SJSFirst 6 to 18 weeksStop immediately. Switch to DTG.
Abbreviations: ADR (Adverse Drug Reaction) · TDF · AZT · ABC · DTG · EFV (Efavirenz) · NVP (Nevirapine) · ATV/r (Atazanavir/Ritonavir) · SJS (Stevens-Johnson Syndrome) · CrCl · CPK (Creatine Phosphokinase) · ULN (Upper Limit of Normal)
References
  1. NACO. National Guidelines for HIV Care and Treatment. MoHFW, GoI; 2021.
  2. NACO. National Technical Guidelines on ART. 2018 (Updated 2021).
  3. WHO. Consolidated guidelines on HIV. 2021.
How to Cite This Tool

AMA: Umakanth S. ART Monitoring, ADR & Substitution Guide. MEDiscuss. Published 2026. Accessed .

Vancouver: Umakanth S. ART Monitoring, ADR & Substitution Guide [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

⚠ Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by
Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic Pathways & Algorithms
Specialties Internal Medicine, Infectious Diseases, HIV Medicine
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